Children's Healthcare of Atlanta, Atlanta, GA.
J Pediatr Orthop. 2023 Aug 1;43(7):460-464. doi: 10.1097/BPO.0000000000002423. Epub 2023 May 1.
The use and misuse of opioid medications is an epidemic and public health emergency. There are currently no standard guidelines for treating perioperative pain in the pediatric population. The purpose of this study is to describe opioid use among pediatric patients after common orthopaedic surgeries.
Patients between 5 and 20 years of age undergoing one of 7 common orthopaedic surgeries between the years 2018 to 2020 were prospectively studied. Patients and their families completed a medication logbook to track all doses of pain medication and associated pain scores.
Three hundred forty-two patients completed the study, including 174 females and 168 males with a mean age of 14.0 years (range, 5 to 20 y). A total of 4351 tablets or liquid doses of the narcotic medication, 44% of the total prescribed, were consumed. Of the prescribed medication,56% remained unused. Nonsteroidal anti-inflammatory drug use was identified to be the only independent predictor of less narcotic use, with a mean of 5.1 tablets ( P = 0.003) and 1.7 days ( P < 0.01) less opioid consumed among these patients. Thirty-two (9.4%) patients consumed 100% of their prescriptions. Nonmedicinal methods of pain control, most commonly ice, were used by 77% of patients, and this was highly variable between procedures. Physicians were cited as a source of medication information by only 50% of patients, with high variability between procedures.
Opioid medication use in children and adolescents after orthopaedic surgery is significantly less than the number of tablets prescribed, with 56% of the medication prescribed remaining unused in the postoperative period. Duration of narcotic use was longer than anticipated with a wide SD (4.7 d +/-3 d).We recommend orthopaedic surgeons responsibly prescribe pain medications using evidence-based data or the results of their own experience monitoring medication consumption. In addition, and important in the setting of the "opioid epidemic," physicians must counsel patients and families on postoperative pain expectations and appropriate medication use.
Level IV, prospective case series.
阿片类药物的使用和滥用是一场流行和公共卫生紧急事件。目前，儿科人群围手术期疼痛的治疗尚无标准指南。本研究的目的是描述常见骨科手术后儿科患者的阿片类药物使用情况。
2018 年至 2020 年间，对 7 种常见骨科手术的 5 至 20 岁患者进行前瞻性研究。患者及其家属完成用药记录册，以记录所有剂量的止痛药和相关疼痛评分。
342 名患者完成了研究，包括 174 名女性和 168 名男性，平均年龄为 14.0 岁（5 至 20 岁）。共消耗了 4351 片或液体剂量的麻醉药物，占总处方量的 44%。规定药物中，56%未使用。非甾体抗炎药的使用被确定为阿片类药物使用量较少的唯一独立预测因素，这些患者的阿片类药物平均使用量减少 5.1 片（P = 0.003），使用天数减少 1.7 天（P < 0.01）。32 名（9.4%）患者服用了 100%的处方药物。77%的患者使用了非药物性止痛方法，最常见的是冰敷，但各手术之间的使用差异很大。只有 50%的患者将医生作为药物信息的来源，而且各手术之间的差异很大。
骨科手术后儿童和青少年的阿片类药物使用量明显低于处方剂量，术后有 56%的药物未使用。阿片类药物的使用时间比预期的要长，标准差较大（4.7 d +/-3 d）。我们建议骨科医生根据循证数据或自己监测药物使用情况的经验合理开具止痛药。此外，在“阿片类药物流行”的背景下，医生必须向患者和家属告知术后疼痛预期和适当的药物使用。
IV 级，前瞻性病例系列研究。
